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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336413282
Report Date: 11/09/2023
Date Signed: 02/22/2024 10:06:39 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/01/2023 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230301155159
FACILITY NAME:TEMPLE COURT SENIOR CAREFACILITY NUMBER:
336413282
ADMINISTRATOR:ESTA HOBBSFACILITY TYPE:
740
ADDRESS:40009 TEMPLE CT.TELEPHONE:
(951) 461-4750
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 0DATE:
11/09/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Esta HobbsTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility staff are not releasing resident's records to resident's authorized respresntative.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility in order to deliver findings for the allegation above. LPA met with Licensee, Esta Hobbs, who was informed of the purpose of the visit.

LPA conducted records review and interviews regarding the allegation that the facility was not providing Resident #1 (R1)'s records to their responsible party. LPA conducted records reviews of text messages sent on 11/11/2022 where R1's daily notes were being requested and staff stated in these texts that R1 did not have any such notes. Staff interview was conducted which corroborated the statements in the text messages. However, upon conducting record review of R1’s file LPA found a caregiver note dated 7/17/2022. Staff was asked about this note and it was revealed that this information was not provided due to requests of incident happening on September 2022 with R1. However, text exchange clearly stated that notes were being requested from July 2022 to September 2022. Therefore, the allegation is substantiated at this time. Findings that are substantiated mean that the preponderance of the evidence standard has been met.

An exit interview was conducted where this report, along with deficiency page, and appeal rights were reviewed and provided to Licensee, Esta Hobbs.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20230301155159
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: TEMPLE COURT SENIOR CARE
FACILITY NUMBER: 336413282
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2023
Section Cited
CCR
87468.2(a)(19)
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(a)...residents...shall have all of the following personal rights:(19)To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days...
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The licensee agreed to provide all records for residents and provide a written statement of this by the POCdue date.
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This requirment was not met as evidenced by: Based on interview and record review, it was found that R1's responsible party was not given access to R1's records. This posed a potential health, saftey, or personal rights risk.
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11/10/2023
Section Cited
CCR
888
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2